| NPI | 1982236741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7104) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7104) |
| 225C00000X Rehabilitation Counselor (Licence: 111708) | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2020-02-10 |