| NPI | 1801447453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LC11562) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: MD LGP9749) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2023-01-17 |