| NPI | 1033429899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 6784) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC6784) |
| 101YM0800X Counselor, Mental Health (Licence: ID NCC-225208) | |
| 101YM0800X Counselor, Mental Health (Licence: OH C.0700919) | |
| 101YP2500X Counselor, Professional (Licence: ID 6784) | |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2024-03-14 |