| NPI | 1033876560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6904) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R6249) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2022-07-16 |