| NPI | 1649779539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC LGPC00308) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP7714) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-02-06 |