| NPI | 1750052742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC015569) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2025-07-23 |