| NPI | 1558691998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7647) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7647) |
| 101Y00000X Counselor (Licence: NC 7647) | |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2017-02-01 |