| NPI | 1073467775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R9138) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 27668) |
| Enumeration Date | 2026-02-21 |
| Last Update Date | 2026-05-08 |