| NPI | 1568046498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH172120) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 16837) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2025-03-27 |