| NPI | 1003092727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 5836) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 3204) |
| 101YM0800X Counselor, Mental Health (Licence: MT 24018) | |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2026-04-15 |