| NPI | 1588071427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LMFT-9960) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10508102-3902) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2024-09-19 |