| NPI | 1932455672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9592) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 9592) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2016-10-14 |