| NPI | 1861694051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LCO791) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2018-12-18 |