| NPI | 1750132809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2026002588) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2024010651) |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2026-01-20 |