| NPI | 1932395522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC14310) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14310) |
| 101YP2500X Counselor, Professional (Licence: MD LC2445) | |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2024-01-25 |