| NPI | 1679314991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ND 1324-9-1-23) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 1324-9-1-23) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-09-18 |