| NPI | 1316201338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ SLPA7857) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AZ SLPA7857) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-08-04 |