| NPI | 1184873952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4070) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-4070) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2024-10-08 |