| NPI | 1164038584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT BBH-LCPC-LIC-57420) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: MT 83795) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2024-02-21 |