| NPI | 1205256146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39003989A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012005) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2021-08-06 |