| NPI | 1356125520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A18694) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC a18694) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-02-10 |