| NPI | 1861565152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ND 602-2-15-08-269) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health (Licence: ND 602-2-15-08-269) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2021-05-05 |