| NPI | 1285953539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MI 6401010973) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39000678A) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |