| NPI | 1396112389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016875) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2015029909) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2022-09-27 |