| NPI | 1023120607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 2097) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 2097) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-07-21 |