| NPI | 1154588176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2000159342) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2000159342) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |