| NPI | 1962091553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC200002435) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2025-12-17 |