| NPI | 1912172982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4636) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2017-10-03 |