| NPI | 1891152047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5452) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R3949) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2023-10-27 |