| NPI | 1770306086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A22810) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A22810) |
| 101Y00000X Counselor (Licence: NC A22810) | |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2026-06-16 |