| NPI | 1609184324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IA 072850) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2010031959) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2022-02-16 |