| NPI | 1619414513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 6605-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 6605-125) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2025-07-02 |