| NPI | 1043984297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A16820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A16820) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2022-05-05 |