| NPI | 1578835971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV 0033) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 0003348) |
| 101YM0800X Counselor, Mental Health (Licence: NV CP0033) | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2024-09-06 |