| NPI | 1538802541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 276747) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO lpc.0018256) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2023-05-01 |