| NPI | 1588398291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 88001671A) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2024-08-14 |