| NPI | 1104011600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6722) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH4084) |
| Enumeration Date | 2007-09-08 |
| Last Update Date | 2012-05-18 |