| NPI | 1184883951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39002140A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 262222) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-11-21 |