| NPI | 1063567550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0005432) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 5432) |
| 101Y00000X Counselor (Licence: CO 5432) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-03-14 |