| NPI | 1568991842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 6961) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-08-19 |