| NPI | 1700269701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC A11212) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC A11212) |
| 101YP2500X Counselor Professional (Licence: NC A11212) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2015-07-08 |