| NPI | 1255526174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 00016) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003993) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2025-08-12 |