| NPI | 1487484978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8670) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC COU.7062.PCI) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-21 |