| NPI | 1720434566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5073) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R4492) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2024-04-14 |