| NPI | 1962517359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3054) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 4901) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2025-01-31 |