| NPI | 1841391505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-675) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0013506) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-03-11 |