| NPI | 1518676402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10353-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5091-226) |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2023-05-05 |