| NPI | 1780299073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC A15906) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: NC A15906) | |
| Enumeration Date | 2020-09-13 |
| Last Update Date | 2020-09-13 |