| NPI | 1902894363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 707) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 707) |
| 101YM0800X Counselor, Mental Health (Licence: AL 707) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-01-20 |