| NPI | 1831458561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5617-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 11075) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-08-24 |