| NPI | 1619134343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2005006924) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2005006924) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2025-07-03 |