| NPI | 1679576532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WV 1683) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WV 1683) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2025-03-17 |