| NPI | 1376361808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD A0966) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD A0966) |
| Enumeration Date | 2024-10-02 |
| Last Update Date | 2025-03-04 |