| NPI | 1104377076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12571) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12571) |
| 101YP2500X Counselor, Professional (Licence: NC 12571) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2025-05-05 |