| NPI | 1881745263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 005130) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 5129) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2019-04-01 |