| NPI | 1629450572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2017009643) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2017009643) |
| 101YP2500X Counselor, Professional (Licence: MO 2017009643) | |
| 103TS0200X Psychologist, School (Licence: MO 38296 NCSP) | |
| 103TS0200X Psychologist, School (Licence: MO 258425) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2019-05-10 |