| NPI | 1386721355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC003377) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 2066) |
| 101YM0800X Counselor, Mental Health (Licence: NC LPC4433) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-12-01 |