| NPI | 1760173090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 7025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH23089) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2024-03-13 |