| NPI | 1306347372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NH 1241) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NH 1241) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2023-06-22 |