| NPI | 1609167915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 8294) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A8294) |
| 101YM0800X Counselor, Mental Health (Licence: NC 8294) | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2021-06-21 |