| NPI | 1942856976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA CSW008544) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: GA CSW008544) | |
| 101Y00000X Counselor (Licence: GA CSW008544) | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2023-04-16 |