| NPI | 1548533144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC008974) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701009184) |
| 101YP2500X Counselor, Professional (Licence: MA 333-MH-CC-TEMP) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701010051) | |
| 101YP2500X Counselor, Professional (Licence: TX 84402) | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2020-11-04 |