| NPI | 1750843587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0017200) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC.0108734) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2021-06-15 |