| NPI | 1326731639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0022720) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 7390-226) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2025-04-02 |