| NPI | 1134178288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: 21658) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 000043) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-07-08 |