| NPI | 1972836963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0144951) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0144951) |
| 101Y00000X Counselor (Licence: NM 0144951) | |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2017-02-14 |