| NPI | 1679133029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39005916A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 77885) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-03-27 |