| NPI | 1306111331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: RI MHC01494) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 66139) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2023-04-20 |