| NPI | 1881714798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0067951) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 8227) |
| 101YP2500X Counselor, Professional (Licence: TX 16743) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2022-06-18 |