| NPI | 1497417935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 70719) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 49010) |
| 101YP2500X Counselor, Professional (Licence: MT 49010) | |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2025-08-11 |