| NPI | 1770952624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 5606) |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2024-03-12 |