| NPI | 1770882961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ME CC1731) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 5106) |
| 101YP2500X Counselor Professional (Licence: TX 63643) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2014-03-26 |