| NPI | 1700559804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R7598) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 307739) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2026-08-04 |