| NPI | 1811441132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: 6401014906) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: 6401014906) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2016-08-04 |