| NPI | 1154508224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 0002400) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM 0734) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2019-03-26 |