| NPI | 1649739863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 5913) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701008229) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-05-02 |