| NPI | 1104446343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 4619) |
| 101YM0800X Counselor, Mental Health (Licence: AL 4619) | |
| 101YM0800X Counselor, Mental Health (Licence: AL C3519A) | |
| 101YP2500X Counselor, Professional (Licence: AL 4619) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2022-03-18 |