| NPI | 1659015006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21726) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701014469) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2026-08-27 |