| NPI | 1366793259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 4783) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 4783) |
| 101YP2500X Counselor, Professional | |
| 101YS0200X Counselor, School (Licence: LA 4783) | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2023-05-30 |