| NPI | 1538889308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 5343225-6004) |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2025-10-17 |