| NPI | 1922613876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LGP10714) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP10714) |
| 101YP2500X Counselor Professional (Licence: MD LGP10714) | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2023-07-03 |