| NPI | 1326101429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5347) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5347) |
| 101YS0200X Counselor, School (Licence: NC 5347) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-23 |