| NPI | 1114138823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL LPC 1177) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL NCC 34447) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |