| NPI | 1720406358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 7680) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-03-04 |