| NPI | 1679103261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 4520) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 4520) |
| 251S00000X (Licence: TN 4520) | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2020-02-04 |