| NPI | 1821353301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3184) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C3184) |
| 101YM0800X Counselor, Mental Health (Licence: OR C3184) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2022-08-21 |