| NPI | 1306999487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP0090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 208165) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2025-09-18 |