| NPI | 1912369331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 4273) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2015028809) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-03-06 |