| NPI | 1083814677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C2938) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C2938) |
| 101YP2500X Counselor Professional (Licence: OR C2938) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2013-03-15 |