| NPI | 1043594963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL SW9961) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KY 356) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |