| NPI | 1750448965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 14957) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 002185) |
| 101Y00000X Counselor (Licence: MA 3864) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2026-06-04 |