| NPI | 1841257037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC S3874) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 3874) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2021-06-23 |