| NPI | 1588087225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 12035) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: C3253) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2018-06-01 |