| NPI | 1902510985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 3163) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AL ALC04160) |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2025-04-29 |