| NPI | 1518220987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-4973) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4973) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2015-06-15 |