| NPI | 1932537255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2022-05-10 |