| NPI | 1427774892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 12056) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.017516) |
| 101YM0800X Counselor, Mental Health (Licence: WI 12056-125) | |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2025-12-10 |