| NPI | 1467812982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 14111) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701006403) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2021-08-30 |