| NPI | 1053323055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-08-17 |