| NPI | 1891515193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101YS0200X Counselor School | |
| Enumeration Date | 2024-10-12 |
| Last Update Date | 2024-10-12 |