| NPI | 1447961123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 12199-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7139-226) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2025-12-04 |