| NPI | 1114704343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2025053505) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: MO 2025053505) |
| 101YM0800X Counselor, Mental Health (Licence: MO 2025053505) | |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2025-12-22 |