| NPI | 1487985487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC007137) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC3047) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2023-01-20 |