| NPI | 1043648454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00742) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: IL 180.0142) | |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2023-07-17 |