| NPI | 1346719390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.009616) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001543) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2018-11-20 |