| NPI | 1073690475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 016190) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC004454) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-06-26 |