| NPI | 1538812573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LPC-22259) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC19708) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2026-02-23 |