| NPI | 1013422849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC7065) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10123) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2018-04-04 |