| NPI | 1780128462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5353) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3133) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2025-11-29 |