| NPI | 1407464365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020021793) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 117233) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2024-10-29 |