| NPI | 1104284413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPP1145) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2023-10-01 |