| NPI | 1659754158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 7558) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7558) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2025-12-23 |