| NPI | 1538415682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 9058) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A9058) |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional (Licence: NC A9058) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2023-04-04 |