| NPI | 1386439875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0701014671) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN 5409) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-04-14 |