| NPI | 1154800563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1808120) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-06-12 |