| NPI | 1003965872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 5063) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MA 5063) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |