| NPI | 1770817918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 11761) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 68207) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2020-04-20 |