| NPI | 1346867447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 283989) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15729) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2023-11-27 |