| NPI | 1821412321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4324) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2104) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2024-03-15 |