| NPI | 1104247147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 13264) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL3998) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2024-07-23 |