| NPI | 1811058027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0001606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 1606) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-03-22 |