| NPI | 1376851626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5746) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 068.0135848) |
| 101Y00000X Counselor (Licence: ID MBTCOU-10130) | |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61571448) | |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC4571) | |
| 101YP2500X Counselor, Professional (Licence: GA LPC015047) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2025-02-02 |