| NPI | 1528404902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022050141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: OK LPC05598) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2025-03-17 |