| NPI | 1134850837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT PCLC-49697) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 1037-LCSW) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-07-21 |