| NPI | 1801051446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 262536) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002025A) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2025-02-06 |