| NPI | 1164400693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9717) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003926) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2013-01-03 |