| NPI | 1770223372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL C4082A) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2024-06-20 |