| NPI | 1821180456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 482) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AK 482) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2026-04-03 |