| NPI | 1871237016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL ALC04100) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL ALC04100) |
| 101YM0800X Counselor, Mental Health (Licence: AL C4100A) | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-02-06 |