| NPI | 1467020628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16684) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A16684) |
| 101YP2500X Counselor, Professional (Licence: NC A16684) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2023-06-20 |