| NPI | 1023475803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 9512) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NH 1203) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2025-02-10 |