| NPI | 1275198244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC9328) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MD 9328) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2020-12-10 |