| NPI | 1417452905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13893) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A13893) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2023-11-27 |