| NPI | 1902008535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 3419) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 3419S) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2021-11-30 |