| NPI | 1043450539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8080) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004355) |
| 101YP2500X Counselor, Professional (Licence: NC 8080) | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2013-06-10 |