| NPI | 1437305109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5320) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2023-12-12 |