| NPI | 1003371667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 2300) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN 2300) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2025-08-13 |