| NPI | 1205518453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 22402) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2024-02-21 |