| NPI | 1497339907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16484) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A16484) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-11-20 |