| NPI | 1316461700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 2165) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WV 2165) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2018-03-08 |