| NPI | 1811398662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 2056) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 1061) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2022-12-07 |