| NPI | 1447695481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 4208) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 4208-125) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2018-12-11 |