| NPI | 1104473545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC15119) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701012997) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2025-04-01 |