| NPI | 1245688746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 286628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60642558) |
| 101YP2500X Counselor, Professional (Licence: OH 2303283) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2023-09-11 |