| NPI | 1285174003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 8570) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 88646) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2025-05-21 |