| NPI | 1487194452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 6755) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 3113226) |
| 101YM0800X Counselor Mental Health (Licence: WI 3113-226) | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2020-03-17 |