| NPI | 1912666785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 11059) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 8103) |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2026-05-05 |