| NPI | 1841676848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10608) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2023-10-18 |