| NPI | 1366615601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00946) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 82499) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2021-05-10 |