| NPI | 1508132879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 003271) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2020-05-14 |