| NPI | 1063651776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 8448) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 9589) |
| 101YM0800X Counselor, Mental Health (Licence: RI MHC00579) | |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2015-05-05 |