| NPI | 1184975781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 8894) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 00112515) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2025-01-15 |