| NPI | 1225420474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC S11175) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701014867) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2025-05-19 |