| NPI | 1558748012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134102) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 1991) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2018-10-29 |