| NPI | 1881433506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11795) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WI 7475-226) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-08-04 |