| NPI | 1609245513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-1119-0) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2025-05-02 |