| NPI | 1770764532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 2203) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC-MH2203) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2024-05-13 |