| NPI | 1174030167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010661) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2322) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2024-12-12 |