| NPI | 1285291088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2676) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 03070) |
| 101YM0800X Counselor, Mental Health (Licence: NE 11855) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 5584) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 2662) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2026-08-11 |