| NPI | 1417651191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-R-3669) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR pending) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-07-13 |