| NPI | 1174492862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA APC010438) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA APC010438) |
| Enumeration Date | 2025-11-01 |
| Last Update Date | 2026-03-04 |