| NPI | 1528359734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0003637) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2009024349) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2018-03-21 |