| NPI | 1396554267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 11266-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 11266125) |
| Enumeration Date | 2025-01-04 |
| Last Update Date | 2025-04-21 |