| NPI | 1003967076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701004274) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ pc00127400) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-11-15 |