| NPI | 1255001798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 19417) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 2693) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2025-08-21 |