| NPI | 1821568189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC11093) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC11093) |
| 101YP1600X Counselor Pastoral (Licence: MD LC11093) | |
| 101YP2500X Counselor Professional (Licence: MD LC11093) | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2021-01-21 |