| NPI | 1114117462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 000551) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR P0503020) |
| 101YM0800X Counselor, Mental Health (Licence: TX 18873) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-20 |