| NPI | 1528168515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC0014771) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14036) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-12-05 |