| NPI | 1346727823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 3143) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 3143) |
| 101YM0800X Counselor, Mental Health (Licence: NH 4732) | |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2026-04-07 |