| NPI | 1598451866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A18455) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 4937) |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2024-01-26 |