| NPI | 1366645632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101Y00000X Counselor (Licence: NC 4677) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2020-01-10 |