| NPI | 1790940914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 7074LMHC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 0002829) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2017-01-11 |