| NPI | 1073206637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CT 008095) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CT 6107) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2025-07-28 |