| NPI | 1306389994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LPC20157) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ LAC-15769) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2021-08-18 |