| NPI | 1497199459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5752) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0082561) |
| 101YP2500X Counselor, Professional (Licence: NM 0158731) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2013-10-10 |