| NPI | 1083133003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AL 3843) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AL C2131A) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2019-01-14 |