| NPI | 1780165696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 124790) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 1892) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2024-10-31 |