| NPI | 1699093856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C3896) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2016-01-20 |