| NPI | 1841763752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-8121) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 011284) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401222794) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2023-07-17 |