| NPI | 1083761357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 231) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4452) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-09 |