| NPI | 1245039809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61652738) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 95879) |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-03-10 |