| NPI | 1023591690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC9392) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP7740) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2020-07-22 |