| NPI | 1609356005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8595125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 3991-226) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2023-03-15 |