| NPI | 1518410679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7969-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: TN LPC0000004490) | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2022-09-02 |