| NPI | 1538656509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC012271) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7263-125) |
| 101YM0800X Counselor, Mental Health (Licence: MN 2127) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2021-07-26 |