| NPI | 1023069572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 6930) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 3462) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |