| NPI | 1104261460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 9409) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC00729) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH19244) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701008982) | |
| 101YP2500X Counselor, Professional (Licence: CA LPCC10669) | |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2022-03-22 |