| NPI | 1790328102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 7966) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: Intern) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2022-05-17 |