| NPI | 1588965511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8103) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 5770) |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2026-08-13 |