| NPI | 1902352545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P2408005) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 06981) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2026-05-29 |