| NPI | 1265891600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 6476-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2090) |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2019-11-12 |