| NPI | 1285252791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3296) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY 2187) |
| 101YP2500X Counselor, Professional (Licence: WY 2187) | |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2026-06-23 |