| NPI | 1003654666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05336) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL LPC05336) |
| 225C00000X Rehabilitation Counselor (Licence: AL 00308022) | |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-31 |