| NPI | 1003124884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 6387) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor Professional (Licence: SC 6387) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2018-03-17 |