| NPI | 1841667227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 7180044-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY LPC-1518) |
| 101YP2500X Counselor, Professional (Licence: ID LPC-4888) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2019-02-08 |