| NPI | 1629743307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-8943) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC61319387) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2023-08-01 |