| NPI | 1831750116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11071) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP9234) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-05-06 |