| NPI | 1285130682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 2282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC6364) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2019-09-13 |