| NPI | 1295204667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 8801) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 8801) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2023-12-28 |