| NPI | 1194843078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 8472) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MA 8972) |
| 101YP2500X Counselor, Professional (Licence: CT 002148) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-08-27 |