| NPI | 1235892852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC13625) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP11895) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2023-03-07 |