| NPI | 1013009562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC LPC5268) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: SC 5268) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-10-28 |