| NPI | 1396454419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-56631) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-68359) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2026-01-07 |