| NPI | 1801582440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 16259) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC013448) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-07-11 |