| NPI | 1215600291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 8321086) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-3394) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2025-12-22 |