| NPI | 1962133082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 17643) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 27570) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2026-07-23 |