| NPI | 1063080646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 5363) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2531) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-06-11 |