| NPI | 1750567202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3794) |
| 101YP2500X Counselor, Professional (Licence: CO 4150) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2025-07-01 |