| NPI | 1316751613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A21053) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC009662) |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-06 |