| NPI | 1144496092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC004835) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003613) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2008-05-01 |