| NPI | 1568813137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0023152) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC0010525) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2025-04-17 |