| NPI | 1215369723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8142) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC S8142) |
| 101YP2500X Counselor, Professional (Licence: NC A8142) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2022-04-18 |