| NPI | 1346727823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 3143) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 4732) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2025-12-14 |