| NPI | 1124733647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MS 2914) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MS 2914) |
| 101YP2500X Counselor Professional (Licence: MS 2914) | |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2024-01-08 |