| NPI | 1992346019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 108844) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.014149) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2022-09-13 |