| NPI | 1679807002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5684) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 10588) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2022-10-11 |