| NPI | 1194101550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 5739) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 5739-125) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2024-07-09 |