| NPI | 1811471766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC6591) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL5121) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2024-02-08 |