| NPI | 1588495279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 8241) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 8241) |
| 101YS0200X Counselor, School (Licence: LA 8241) | |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-13 |