| NPI | 1144398322 |
|---|---|
| Former Name | LISA ANN MILLER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 4001) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 002081) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2012-10-31 |