| NPI | 1265451843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2001025351) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2001025351) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-03-31 |