| NPI | 1992289961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11456-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0019077) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2025-05-12 |