| NPI | 1417918723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1554) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA LA1554) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2024-01-19 |