| NPI | 1992218036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 174H00000X Health Educator | |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2024-03-24 |