| NPI | 1174632814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 3692) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 00892) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-05-16 |