| NPI | 1902305402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 2016028726) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2016028726) |
| 101YP2500X Counselor Professional (Licence: MO 2016028726) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 2016028726) | |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2018-02-09 |