| NPI | 1417798166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-10577) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R12360) |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2026-07-21 |