| NPI | 1396279220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN 3869) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 3869) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2018-07-18 |