| NPI | 1164140893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 21206) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2024-09-20 |