| NPI | 1013062231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0003691) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 3691) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2016-02-11 |