| NPI | 1457824633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16361) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 9829) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2025-12-01 |