| NPI | 1407419021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2019012957) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2019012957) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2023-04-18 |