| NPI | 1871022418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014024) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-6139) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2018-05-25 |