| NPI | 1255088589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 4803) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2025-02-20 |