| NPI | 1730278854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 0100411) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM 0100411) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-10-15 |