| NPI | 1649895731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 12221) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 12221) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2022-10-19 |