| NPI | 1891440475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM C-12097) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA CW021943) |
| Enumeration Date | 2022-02-13 |
| Last Update Date | 2022-02-13 |