| NPI | 1124452123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC6147) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MD LC6147) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2022-06-13 |