| NPI | 1033503073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2026-06-08 |