| NPI | 1447441100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 11452) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH9031) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2025-12-18 |