| NPI | 1710202130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc02604) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK cc) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2025-10-20 |