| NPI | 1548665052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 46.003756) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 261QP2300X Clinic/Center, Primary Care (Licence: CT 3756) | |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2022-04-01 |