| NPI | 1003311622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 2382) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL4966) |
| 101YM0800X Counselor, Mental Health (Licence: ME CC5792) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-04-13 |