| NPI | 1851010565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05359) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 12787429-6004) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-02-24 |