| NPI | 1336662188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1807) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 1807) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2022-08-22 |