| NPI | 1104431584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 3661) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2020011716) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2024-06-05 |