| NPI | 1801365705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: GA LPC011183) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA APC006213) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2021-07-21 |