| NPI | 1902518962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC-0011614) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701012029) |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2025-10-13 |