| NPI | 1497453898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 5511) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL ALC04412) |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2025-02-04 |