| NPI | 1861178485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 2740) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WV 718) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-04-15 |