| NPI | 1083861728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM 0217661) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM CCMH0217661) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2024-12-13 |