| NPI | 1861545378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 1188) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1024828) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-02-21 |