| NPI | 1013934090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC000664) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2017-10-04 |