| NPI | 1174098115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2018037840) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2025-08-22 |