| NPI | 1376139642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P2208022) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: A2011175) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2022-12-06 |