| NPI | 1538479795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 5029) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2019-12-19 |