| NPI | 1811367501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 6251) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC007609) |
| 101YP2500X Counselor, Professional (Licence: NC 13914) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2020-06-24 |