| NPI | 1700553054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc05020) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 111708) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2026-07-29 |