| NPI | 1033778105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LPCP-LIC-38064) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 11694219-3902) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2025-05-08 |