| NPI | 1639621410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39002942A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0013449) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2023-02-09 |