| NPI | 1902132228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 5814) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 5814) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2020-11-25 |