| NPI | 1023304706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CT 002028) | |
| 101YP2500X Counselor, Professional (Licence: CT 002028) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-04-28 |