| NPI | 1114644531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5021) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 101YM0800X) |
| 101YP2500X Counselor, Professional (Licence: OR C5021) | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2022-10-26 |