| NPI | 1487192209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP5548-R) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH19220) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2023-11-06 |