| NPI | 1891983607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2949) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AK AK300) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2024-11-27 |