| NPI | 1497831622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 3977-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178003890) |
| 101YM0800X Counselor, Mental Health (Licence: NM 0080251) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2009-06-04 |