| NPI | 1093254682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 3896) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IA 085718) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3896) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2024-11-02 |