| NPI | 1023484516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV DP00941308) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 02517) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0904006979) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |