| NPI | 1154524858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174400000X Specialist | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-07-14 |