| NPI | 1104951763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 2919) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2919) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-09 |