| NPI | 1356488936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16504) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 3486) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2026-02-02 |