| NPI | 1639485915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 2308) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 38) |
| 273R00000X Psychiatric Unit (Licence: WV 38) | |
| 101YM0800X Counselor, Mental Health (Licence: KS 2308) | |
| 101Y00000X Counselor (Licence: KS 2308) | |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2013-05-29 |