| NPI | 1184335556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MT BBH-PCLC-LIC-57505I) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-57505) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-08 |