| NPI | 1073858031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 5301) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 5301) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2023-03-21 |