| NPI | 1184724148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ND 51161504151) |
| 101Y00000X Counselor (Licence: ND 51161504151) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-02-12 |