| NPI | 1982044046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 9141) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 941) |
| 101YP2500X Counselor Professional (Licence: NC 9141) | |
| 225C00000X Rehabilitation Counselor (Licence: 00113409) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-08-09 |