| NPI | 1265144695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC15740) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LC15740) |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2025-06-26 |