| NPI | 1538151766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 2005) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3177) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-11-14 |