| NPI | 1164501243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC0000265) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: DE 2003102335) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2026-03-04 |