| NPI | 1194104174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 19332) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 6094) |
| Enumeration Date | 2015-05-24 |
| Last Update Date | 2024-01-04 |