| NPI | 1508396714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 8321712) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-6599) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-12-22 |