| NPI | 1548758824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA LPC012469) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA APC005684) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-01-19 |