| NPI | 1972368462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 103T00000X) |
| 225XM0800X Occupational Therapist, Mental Health (Licence: OR 225XM0800X) | |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-11-07 |