| NPI | 1891244380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 12465) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor Professional | |
| 225C00000X Rehabilitation Counselor (Licence: IL 179938) | |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2024-01-22 |