| NPI | 1588189740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7479-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 3622-226) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2022-08-08 |