| NPI | 1740675917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC200002000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 101YP2500X) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-05-30 |