| NPI | 1063566651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3752-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 3752125) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2016-10-18 |