| NPI | 1629426010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-06-28 |