| NPI | 1861147902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 5313) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 005313) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2023-11-20 |