| NPI | 1942864962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 14814) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 009305) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2021-07-01 |