| NPI | 1811491673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12686) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12686) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-11-20 |