| NPI | 1063299840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI mhc-981) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 9153) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2026-03-05 |