| NPI | 1801127964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 4228) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 4228) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2025-09-23 |