| NPI | 1215749064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MG61623273) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 4681) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-05-01 |