| NPI | 1073912762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 1907) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 1907) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2018-06-25 |