| NPI | 1205886363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 3565) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 3565) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-12-20 |