| NPI | 1730765934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ID LPC-7839) |
| 101Y00000X Counselor | |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2024-09-25 |