| NPI | 1083948756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0126121) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC4970) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2023-01-08 |