| NPI | 1720390115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 2466) |
| 101YS0200X Counselor, School (Licence: CT 4991824780) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2019-06-11 |