| NPI | 1467214452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL LPC05143) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL LPC05143) |
| 101YP2500X Counselor, Professional (Licence: AL LPC05143) | |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-01-25 |