| NPI | 1518529981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 10476-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 10476-125) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2025-06-05 |