| NPI | 1083586069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 12283.125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 8143) |
| Enumeration Date | 2025-09-19 |
| Last Update Date | 2026-02-02 |