| NPI | 1073689659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT 1456) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AK 398) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2022-10-04 |