| NPI | 1720558679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12619) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC QS135919) |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2025-12-09 |