| NPI | 1093442188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A21690) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2025-07-25 |