| NPI | 1477420685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 7371085) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 7371085) |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-12-26 |