| NPI | 1235960733 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 10653) | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| Enumeration Date | 2024-08-08 | 
| Last Update Date | 2025-07-25 |