| NPI | 1083933543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC007863) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 7693) |
| 101Y00000X Counselor (Licence: MD LC4994) | |
| 101YM0800X Counselor, Mental Health (Licence: NC 7693) | |
| 101YM0800X Counselor, Mental Health (Licence: MD LC4994) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2023-11-11 |