| NPI | 1679387039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701014900) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0704013290) |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-05-22 |