| NPI | 1285937011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 8334) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 8334) |
| 101YP2500X Counselor Professional (Licence: NC S8334) | |
| 101Y00000X Counselor (Licence: NC 8334) | |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2024-01-03 |