| NPI | 1366193385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10696) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2804) |
| 101YM0800X Counselor, Mental Health (Licence: WI 5175) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2025-01-27 |