| NPI | 1205074176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C 3826) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2015-08-25 |