| NPI | 1902249741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 6202) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 90496) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2026-03-23 |