| NPI | 1700410024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15598) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15598) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2022-06-24 |