| NPI | 1447455050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 2694) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2694-125) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2024-07-29 |