| NPI | 1841800166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 103TC1900X Psychologist, Counseling | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-01 |
| Last Update Date | 2024-05-19 |