| NPI | 1174347371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019910) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-11-13 |