| NPI | 1689366387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 12154-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7339-226) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-11-04 |