| NPI | 1376665489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0016709) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 62-226) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-12-25 |