| NPI | 1336818228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC14764) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: MD LC6819) | |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2021-09-13 |