| NPI | 1841723376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A12886) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 070104479) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-02-21 |