| NPI | 1760888648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 10589) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A10589) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2017-05-18 |