| NPI | 1386235117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 50323) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701009892) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2024-05-21 |