| NPI | 1013112150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH4573) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5258) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2007-07-08 |