| NPI | 1639155146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0088161) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0088161) |
| 101YS0200X Counselor, School (Licence: NM 0088161) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |