| NPI | 1548931942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: 6881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 6881) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2021-09-24 |