| NPI | 1578869426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0022066) |
| Additional Taxonomies | 174400000X Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2025-04-07 |