| NPI | 1528195419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 1422) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 1244) |
| 101YM0800X Counselor, Mental Health (Licence: NC 1422) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2025-09-11 |