| NPI | 1891351995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 5265) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2499) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-05-14 |