| NPI | 1568034635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 19746) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2024-02-22 |