| NPI | 1366820839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 5604) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 5604) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2024-02-02 |