| NPI | 1295353381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC A17092) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 178.015601) |
| 101YP2500X Counselor Professional (Licence: IL 178.015601) | |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2021-12-02 |