| NPI | 1841488319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 5585) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 5585) |
| 101YS0200X Counselor School (Licence: NC 5585) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2020-08-07 |