| NPI | 1932035292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-24301) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180016333) |
| Enumeration Date | 2026-06-23 |
| Last Update Date | 2026-06-23 |