| NPI | 1245848134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC TLC267PC) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC3905) | |
| 101YP2500X Counselor, Professional (Licence: SC TLC267PC) | |
| 101YP2500X Counselor, Professional (Licence: NC 16025) | |
| 101YP2500X Counselor, Professional (Licence: FL TPMC3905) | |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2024-11-20 |