| NPI | 1124459524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 011143) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60547238) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00707500) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0015458) | |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2022-03-28 |