| NPI | 1245939768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R8110) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH22634) |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-11-01 |