| NPI | 1255703856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 2759 - 226) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 2759 - 226) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |