| NPI | 1154103299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 5406C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 5406C) |
| 101Y00000X Counselor (Licence: AL 5406C) | |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-12-07 |