| NPI | 1154034148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A22213) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 117917) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2025-12-08 |