| NPI | 1225315211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC351) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2026-02-18 |