| NPI | 1679690820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021021781) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8288) |
| 101YP2500X Counselor, Professional (Licence: KY 170707) | |
| 101YP2500X Counselor, Professional (Licence: TX 19778) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-07-12 |