| NPI | 1790232270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 4399) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12484) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-04-12 |