| NPI | 1699330175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC10100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-02-11 |