| NPI | 1114015039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2009023490) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC3685) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-01-07 |