| NPI | 1326162967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 81648) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 3105) |
| 101YM0800X Counselor, Mental Health (Licence: 81648) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-09-11 |