| NPI | 1831521798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 252582) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN LPC0000005569) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH-61163612) | |
| 101YM0800X Counselor, Mental Health (Licence: IL 180008178) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401016742) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2024-12-27 |