| NPI | 1578263232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR R8218) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-05-24 |