| NPI | 1841963311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2020025030) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 3660) |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2021-07-29 |