| NPI | 1962912501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 10540388-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-16935) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2025-10-07 |