| NPI | 1871960112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2015034337) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL LPC04789) |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2025-08-30 |