| NPI | 1093307431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A16343) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2022-08-03 |