| NPI | 1548533706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL LPC3778) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL MH10562) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2019-03-10 |