| NPI | 1720158389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| 101Y00000X Counselor (Licence: NC 5481) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-04-04 |