| NPI | 1972130706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 6810-125) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WI 6810-125) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-04-01 |