| NPI | 1487105524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8160-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP5363) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2022-03-08 |