| NPI | 1952771891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 7628) |
| 251S00000X | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2023-08-10 |