| NPI | 1033355797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 750) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 426) |
| 101YM0800X Counselor, Mental Health (Licence: CO 6033) | |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2009-01-15 |