| NPI | 1457122715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8971) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 8971) |
| 101Y00000X Counselor (Licence: SC 8971) | |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2026-08-05 |