| NPI | 1962106054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC014794) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 12008) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2026-04-10 |