| NPI | 1861669285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 13296176-6004) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2026-05-05 |