| NPI | 1487103701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 3595) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MI 6401224036) |
| 101YM0800X Counselor Mental Health (Licence: KY 279920) | |
| 101YM0800X Counselor Mental Health (Licence: TN 3595) | |
| 101YM0800X Counselor Mental Health (Licence: OK 12106) | |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2024-04-18 |