| NPI | 1255888780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 3300) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 081199) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-06-09 |