| NPI | 1790700565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT 137) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT 137) |
| 174400000X Specialist (Licence: MT 137) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-03-11 |