| NPI | 1144704024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC015348) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2024-12-23 |