| NPI | 1831523422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0013711) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1503-226) |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2018-05-23 |