| NPI | 1740989912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC17626) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP13604) |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2026-06-16 |