| NPI | 1265238927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-PCLC-LIC-48307) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-60333) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-03-08 |