| NPI | 1649819723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 8340) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 8340) |
| 101YP2500X Counselor, Professional (Licence: SC 8340) | |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2023-06-18 |