| NPI | 1881732618 |
|---|---|
| Former Name | NICOLE MARIE WILDES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 6217) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2023-08-24 |