| NPI | 1811555030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC10233) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional (Licence: VA 0701010194) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-12-09 |