| NPI | 1518190768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN 5520) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LCPC-8139) |
| 174M00000X Veterinarian (Licence: WA VT00008214) | |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2023-09-15 |