| NPI | 1871966150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 11786) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701012486) |
| 101YP2500X Counselor Professional (Licence: AL 04767) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2023-10-02 |