| NPI | 1639571953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8059473-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0988) |
| 101YP2500X Counselor, Professional (Licence: ID 3440) | |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-17 |