| NPI | 1437665759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 5312) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2515) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2024-02-07 |