| NPI | 1265068340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc02400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2024-06-20 |