| NPI | 1093859274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 5592) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 890) |
| 101YM0800X Counselor, Mental Health (Licence: LA 2554) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2008-01-10 |