| NPI | 1144939489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2025020602) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 04147) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2025-10-21 |