| NPI | 1588080279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 18173) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 8511927-6010) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2024-04-16 |