| NPI | 1407732068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 11484) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 7532) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-10-29 |