| NPI | 1669181103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0018452) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0018452) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2025-01-15 |