| NPI | 1740774736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13979) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A13979) |
| 101YP2500X Counselor, Professional (Licence: NC A13979) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-05-18 |