| NPI | 1386863694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 4613-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 4613-125) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2014-10-08 |