| NPI | 1700207370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5441) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 4212-120) |
| 101YM0800X Counselor, Mental Health (Licence: WI 970-226) | |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2024-05-14 |