| NPI | 1811236029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018043349) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-5012) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2024-06-24 |