| NPI | 1508526443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-8743) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID COUI-8559) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2024-04-14 |