| NPI | 1720742414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AK 170303) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 7863) |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2022-12-09 |