| NPI | 1508314915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8091-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2024-10-15 |