| NPI | 1477215341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC14397) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP11982) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2024-03-01 |