| NPI | 1871052134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3647) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 40038) |
| 101YP2500X Counselor, Professional (Licence: MT BBH-PCLC-LIC-32427M) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2024-07-24 |