| NPI | 1457909608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A14186) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A14186) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2021-12-06 |