| NPI | 1679932149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 0431) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 0431) |
| 101YM0800X Counselor Mental Health (Licence: MS 0431) | |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |