| NPI | 1588428080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC014977) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C9770) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-09-08 |