| NPI | 1154961027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2017043977) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 22955) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2023-12-08 |