| NPI | 1770343857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 2768) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 101yp2500x) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-28 |