| NPI | 1982227211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 2019013489) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2019013489) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-05-21 |