| NPI | 1831534486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 5757) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SC 5560) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2015-06-10 |