| NPI | 1598449696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD B500035824131) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |