| NPI | 1598496309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 8831378) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C10498) |
| 101YM0800X Counselor, Mental Health (Licence: LA 11072) | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2026-03-17 |