| NPI | 1093089492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS CH1823) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2014-06-23 |