| NPI | 1700764701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA APC001488) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC00343-A) |
| Enumeration Date | 2025-08-26 |
| Last Update Date | 2025-08-26 |