| NPI | 1710302898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2013043958) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 7124) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2019-06-10 |