| NPI | 1225750078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3457) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 2872) |
| 101YM0800X Counselor, Mental Health (Licence: IA 136012) | |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2026-04-28 |