| NPI | 1245180959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 101185) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A22668) |
| Enumeration Date | 2026-02-02 |
| Last Update Date | 2026-04-13 |