| NPI | 1285770107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 6306) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: MA 4368) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-11-02 |