| NPI | 1578452850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A20754) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NC 1242639) |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2025-07-01 |