| NPI | 1083753719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME 329880) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 5607) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |