| NPI | 1578157475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C10353) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-9008) |
| 101YP2500X Counselor, Professional (Licence: ID LPC-9008) | |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2026-02-20 |