| NPI | 1700516986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL LPC05438) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: AL T21263) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2026-05-29 |