| NPI | 1679072912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018907) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH17435) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-08-12 |