| NPI | 1710508536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC a15382) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A15382) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2020-06-01 |