| NPI | 1609906965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC-0000623) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DE 351) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2026-04-02 |