| NPI | 1598549149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R9267) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-04-23 |