| NPI | 1881433506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 7475-226) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: WI 7475-226) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-06-26 |