| NPI | 1083188072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 19234) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC11338) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2024-01-08 |