| NPI | 1508631920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0021236) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-10-10 |