| NPI | 1144208927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 4358) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 4358) |
| 101YM0800X Counselor Mental Health (Licence: NC 4358) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2024-02-12 |