| NPI | 1134191190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LCS 17532) |
| Additional Taxonomies | 171W00000X Contractor (Licence: CA LCS 17532) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-07-08 |