| NPI | 1871150102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11668) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LG8904) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2023-07-17 |