| NPI | 1801842588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AL 345) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH4029) |
| 103TR0400X Psychologist Rehabilitation (Licence: TN 1064) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-04-16 |