| NPI | 1346987773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC015358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 11121) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2025-08-04 |