| NPI | 1144742339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 13030) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 11141) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2025-06-29 |