| NPI | 1477241834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC200001807) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701012378) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-10-04 |