| NPI | 1528679818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22768) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 9369) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2026-05-19 |