| NPI | 1659873925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015635) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH16100) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2023-12-29 |