| NPI | 1427176825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MA 11411) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2023-10-31 |