| NPI | 1942437579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 8661) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 2799) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2026-02-26 |