| NPI | 1528617925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15146) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2019-09-09 |