| NPI | 1770979791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7441) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10655) |
| 101YP2500X Counselor, Professional (Licence: NM CCMH0192341) | |
| 101YP2500X Counselor, Professional (Licence: NV CP3264-R) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701012168) | |
| 101YP2500X Counselor, Professional (Licence: PR 004576) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-10-27 |