| NPI | 1508077967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC3048) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP323) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-01-02 |