| NPI | 1184376329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3062) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12351) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2023-08-07 |