| NPI | 1396862744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC004855) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC004855) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2017-03-13 |