| NPI | 1760073670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0207001) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008.008) |
| 101YP2500X Counselor, Professional | |
| 101YP2500X Counselor, Professional (Licence: MO 2007028089) | |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2023-04-20 |