| NPI | 1134632755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY 1670) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 13697) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2021-08-04 |