| NPI | 1003159278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC6790) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 7433037-6004) |
| 101YP2500X Counselor, Professional (Licence: PA PC008632) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2016-05-23 |