| NPI | 1821391525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 8076) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: ID 8076) | |
| 101YP2500X Counselor, Professional (Licence: MN 01913) | |
| Enumeration Date | 2010-12-19 |
| Last Update Date | 2023-03-23 |