| NPI | 1730645235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0016553) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0018206) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2023-07-21 |