| NPI | 1558780338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-LCPC-LIC-16294) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2019-01-16 |