| NPI | 1790197986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10620) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A10620) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2020-03-27 |