| NPI | 1649161605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 14220) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 8132) |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-07-09 |