| NPI | 1215758057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 22007) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0023914) |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2026-07-08 |