| NPI | 1376268904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC15349) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP12777) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2026-06-08 |