| NPI | 1508983024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2002013516) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2002013516) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-09-18 |