| NPI | 1558079319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA APC000539) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 89266) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2024-11-14 |