| NPI | 1740066984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC16866) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP14251) |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2025-08-22 |