| NPI | 1720593783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12656) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 757108) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2026-01-26 |