| NPI | 1265611024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA PSB94023546) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 3912) |
| 101Y00000X Counselor (Licence: OK 3912) | |
| 101YS0200X Counselor, School (Licence: OK 3912) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2019-01-04 |