| NPI | 1912269838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC-6532) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6532) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2018-12-11 |