| NPI | 1306490313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 11868) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 11868) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2020-05-21 |