| NPI | 1518398932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 11027) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI 519) |
| 101YP2500X Counselor, Professional (Licence: TN 3090) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2025-01-08 |