| NPI | 1821129230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 4641) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1108) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2025-12-08 |