| NPI | 1679621809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC1364) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC0481) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-09-30 |