| NPI | 1417447616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 009617) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: AL 3245) | |
| 101YM0800X Counselor, Mental Health (Licence: TN 3571) | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2019-04-11 |