| NPI | 1568028975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR R6234) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health (Licence: NE 11838) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-03-07 |