| NPI | 1184701286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC S5114) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5114) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-08-30 |