| NPI | 1508337999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0094986) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009229) |
| 101YM0800X Counselor, Mental Health (Licence: UT 11041667-6004) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2018-12-10 |