| NPI | 1710054101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 3484-125) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 3484-125) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-01-08 |