| NPI | 1154675494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 2011024362) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2011024362) |
| 101YP2500X Counselor Professional (Licence: MO 2011024362) | |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2018-09-25 |