| NPI | 1114916624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 4155) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 4155) |
| 101YP2500X Counselor Professional (Licence: NC 4155) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2022-04-06 |