| NPI | 1326563479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A13224) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A13224) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2018-09-19 |