| NPI | 1063058451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC200001188) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC LGPC00568) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2021-09-01 |