| NPI | 1972062438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 11110) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |