| NPI | 1164183356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS P-1301) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AR A2208031) |
| 101YM0800X Counselor, Mental Health (Licence: AR A2208031) | |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2025-07-21 |