| NPI | 1235431925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C3884) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 7562) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2024-09-12 |