| NPI | 1780399808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner (Licence: FL 2054) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2023-02-14 |