| NPI | 1609341114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 6850) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 010628) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2025-04-12 |