| NPI | 1073683397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 2282) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 009203) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |