| NPI | 1134537657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 10991) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 10991) |
| 101YM0800X Counselor, Mental Health (Licence: NC 10991) | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2018-05-25 |