| NPI | 1316310253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P2107012) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO LPC.0012677) |
| Enumeration Date | 2015-10-31 |
| Last Update Date | 2021-11-29 |