| NPI | 1235782293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C6589) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR R6009) |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2022-04-04 |