| NPI | 1861903205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 12924) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: 110912) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2020-01-14 |