| NPI | 1750946950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN 6062) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MN 3369) |
| 101YM0800X Counselor Mental Health (Licence: FL IMH18270) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2024-07-02 |