| NPI | 1750045837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 334) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 265) |
| 101YP2500X Counselor, Professional (Licence: NV 2835) | |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2021-10-26 |