| NPI | 1811777907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4516) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 13632) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3167) | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2026-03-24 |