| NPI | 1366209595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IA 123981) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IA 123981) |
| 101YP2500X Counselor Professional (Licence: IA 123981) | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-07 |