| NPI | 1194350843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 7572) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2022-11-07 |