| NPI | 1326754151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 150.110236) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 14623) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-06-10 |