| NPI | 1184257917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17932) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C10814) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2026-08-31 |