| NPI | 1780287391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 111716) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2024-05-01 |