| NPI | 1679296479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2025006978) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C8656) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2026-08-29 |