| NPI | 1619436359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 88003290A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 307009) |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2026-05-20 |