| NPI | 1013361922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC6982) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC PRC14773) |
| Enumeration Date | 2016-04-17 |
| Last Update Date | 2017-02-27 |