| NPI | 1811316904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 10000016) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-01-31 |