| NPI | 1285905331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2790) |
| Enumeration Date | 2012-01-21 |
| Last Update Date | 2023-12-03 |