| NPI | 1508212812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN 2052) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 10678) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2023-03-28 |