| NPI | 1417536160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 12921613-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-01-22 |