| NPI | 1215253620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1326) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 1326) |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2024-02-08 |