| NPI | 1760867105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI 00932) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 10472) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2018-04-09 |