| NPI | 1386717445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 576) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3039) |
| 101YP2500X Counselor, Professional (Licence: NE 1574) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-06-05 |