| NPI | 1215454202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 13230) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 13230) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-05-16 |