| NPI | 1528302569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KS 2614) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002409A) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2018-08-13 |