| NPI | 1538280805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPCMH2065) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH2065) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2023-02-02 |