| NPI | 1588189070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 12816) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 12816) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2025-06-11 |