| NPI | 1497443030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 11819-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 7260-226) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2025-05-23 |