| NPI | 1124218060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 6982) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 357) |
| 101YP2500X Counselor, Professional (Licence: MO 2012042240) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2023-02-28 |