| NPI | 1538744560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC012033) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-16164) |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |