| NPI | 1912983446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 325010-6004) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2021-01-06 |