| NPI | 1447840053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61085057) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 010034) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-19 |