| NPI | 1376196733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 14969) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 14969) |
| 101YP2500X Counselor, Professional (Licence: NC A14518) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2023-08-15 |