| NPI | 1083897847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 5753) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MA 1817) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2007-12-14 |