| NPI | 1174155675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15560) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15560) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2022-10-11 |