| NPI | 1205426244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 10262) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| 101Y00000X Counselor (Licence: WI 10262125) | |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2026-02-17 |