| NPI | 1932708534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP10771) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2023-07-31 |