| NPI | 1508487976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC015458) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61301380) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.013996) | |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-04-14 |