| NPI | 1932960531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2023042205) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2023042205) |
| 163W00000X Registered Nurse (Licence: MO 145750) | |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-02-14 |