| NPI | 1992458764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 8908) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 8908) |
| 101YP2500X Counselor Professional (Licence: SC 8908) | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-03-13 |