| NPI | 1114181351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC C008798) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 06294) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2021-03-16 |