| NPI | 1982198693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 6296) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: LA 6296) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2022-08-08 |