| NPI | 1700559804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R7598) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 286535) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2023-09-11 |