| NPI | 1033986484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 18110) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A18110) |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2024-12-27 |