| NPI | 1225676034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 4546) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL C2482A) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2022-10-03 |