| NPI | 1619938107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC2621) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC2621) |
| 101YP2500X Counselor, Professional (Licence: MD LC2621) | |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2023-06-13 |